ABSTRACT
BACKGROUND: Regular abdominal massage can be used to treat digestive symptoms such as bloating and constipation and is reported to reduce abdominal discomfort, improve digestive function, and increase the quality of life, without serious adverse effects. Isolated pancreatic injury is rare, and most often occurs during severe trauma such as steering wheel impact injury. To our knowledge, pancreatic injury caused by massage has not yet been reported in the literature. CASE SUMMARY: A 57-year-old woman was referred to our hospital for acute abdominal pain and transient syncope. On examination, she had low hemoglobin concentration and a high white blood cell count and neutrophil percentage. Plain computed tomography of the abdomen revealed a substantial hemorrhage in the abdominal cavity. A large amount of exudate in the pancreatic area was considered a hematoma. Preoperative diagnosis was difficult. Her hemoglobin and blood pressure did not rise even after blood. We suspected progressive bleeding in the abdominal cavity and urgently performed exploratory laparotomy. During the operation, the pancreas was confirmed to be ruptured; hence, spleen-preserving pancreatic body and tail resection were performed. A pancreatic fistula was found on the 15th d after the operation, and the patient was discharged with a drainage tube on the 24th d after active treatment. Subsequently, it was discovered that the patient had undergone a vigorous abdominal massage the day before the abdominal pain began. To our knowledge, this is the first report of isolated pancreatic injury and massive abdominal hemorrhage caused by abdominal massage. CONCLUSION: Our findings indicate that any action that increases intra-abdominal pressure may cause internal organ damage. We also review similar cases reported in the literature.
ABSTRACT
INTRODUCTION AND IMPORTANCE: To describe an unusual case with a primary hepatic neuroendocrine tumour (PHNET) with multiple liver metastases. CASE PRESENTATION: We reported a 65-year-old woman with PHNET with multiple liver metastases. She was highly suspected of having primary liver cancer with multiple intrahepatic metastases before liver biopsy, but was diagnosed with PHNET with multiple liver metastases after histopathology and immunohistochemistry (IHC) examinations. The patient successfully underwent three times of transcatheter arterial chemoembolization (TACE), and is currently living in a good state without related complications. CLINICAL DISCUSSION: Neuroendocrine tumors (NETs), also known as carcinoids or argyrophilic tumors, are very rare malignant tumors. The liver is the main metastasis site of NETs, but primary hepatic neuroendocrine tumors (PHNETs) are extremely rare. Histopathology and immunohistochemistry (IHC) examinations are still the main methods used for diagnosing NETs. There are no treatment guidelines for PHNETs, and surgical resection is generally the preferred treatment. For PHNET patients who are not suitable for surgery, TACE has been proven to be an effective alternative treatment that can effectively reduce the tumour burden and relieve symptoms, but the current evidence is still limited. CONCLUSION: The clinical diagnosis of PHNET still faces great challenges, imaging examinations often lead to misdiagnosis, and its diagnosis mainly depends on histopathology and immunohistochemical examinations. For PHNET patients who are not suitable for surgery, TACE may be an effective alternative therapy.
